Environmental and societal factors affect food choice and physical activity: Rationale, influences, and leverage points

Dietary and physical activity behaviors that affect health are influenced by a wide variety of forces; changes in these behaviors require interventions and commitment to action at multiple levels.l.2 Education-based obesity-prevention strategies (e.g., mass-media promotion of healthy foods and promotion of healthy physical activity habits through schools) are viewed as the most useful and the most feasible to im~lementIm.~p licit in these strategies is the focus on the individual? Education-based strategies have met with limited long-term success in changing behavior: however, perhaps owing to a general lack of supporting environmental modifications. There is increasing recognition of the importance of the environment in shaping behavior, yet strategies that focus on changing environmental factors are much less familiar, and may therefore require partnerships with relevant sectors outside traditional health domains. As described in greater detail by Economos et al.: partnerships among researchers, educators, government, and industry have demonstrated success in smoking reduction at the population level. Interventions such as taxation and advertisement regulations have been instrumental in promoting smoking cessation in the United States and are used by agriculture and agribusiness interests to promote specific food consumption patterns. Similar models of collaborations or interventions may be successful in changing food intake and physical activity, and may potentially result in such desirable outcomes as prevention and reduction of obesity.6 It is important to appreciate the interaction among multiple environmental factors and that complex behavior changes are dependent on different influences at different levels. In Working Group 11, we took on the task of identifying broader contextual, environmental, societal, and policy variables that may improve our understanding of people's eating and physical activity behaviors and may lead to new directions for influencing shifts in behavior. Ecologic models of behavior, and most health promotion models, specify that health behaviors be influenced by biologic, demographic, psychological, sociaYcultura1, environmental, and policy variables. However, the research base that identifies specific important environmental and policy variables is very limited.'.""' Nevertheless, there are several reasons that support the need to identify environmental and policy influences on physical activity and eating behaviors